The treatment planning of a teen patient who has lost an anterior tooth can present restorative dentists with the dilemma of immediate esthetics against the need to wait for definitive therapy. This scenario is extremely common – in fact, most practitioners have or will treat this type of patient.

ovate pontic figure 1

Since people continue to grow well into their late teens and even early twenties, they may not be a candidate for an implant For teens who don’t want to opt for a flipper to disguise their missing tooth, the area can be treated with a fixed bridge. The goal of an ovate pontic treatment is to create a natural appearance and the following steps will guide you to an ideal result.

Step 1: Create lingual. After your model is made, take a colored pencil and draw a curved line over the absent tooth that mimics the lingual over the adjacent tooth. Now take a round-end acrylic burr and carve the model down to that line and extend it about 1mm deeper.

Step 2: Prep pontic site. Once you get the pontic made and the site is anesthetized, make an incision to the bone between the buccal and ridge. The more lingual you go, the more volume of tissue you’ll get in terms of plumping. However, the more lingual you go, the harder it is to put the pontic into place.

Step 3: Create pouch. After making your blunt incision, use the back of the curette to peel the periosteum away from the bone. The pouch needs to be released enough for the pontic to place and have tissue fall correctly around it.

Step 4: Place pontic. The challenge of a single pontic is positioning it correctly. It quite common for a pontic to tip on you and doesn’t align correctly with the other teeth. Making a copyplast stent will help guide the pontic into alignment with the rest of the patient's teeth.

Step 5: Move tissue and stabilize. After placing the pontic, take an interproximal carver to carefully place tissue around the pontic. As the tissue continues to fall around the facial, the pontic will fit right into place. Now insert that same copyplast stent to stabilize teeth and leave it on for 10 to 15 minutes to allow it to set.

Step 6: Bond pontic into place. After particle abrading the wings and interproximal, remove pontic and etch the adjacent teeth. To prevent bleeding, slightly infiltrate the ridge with an anesthetic with a vasoconstrictor to enhance hemostasis. Paint on the adhesive, place pontic and activate the bonding process with a curing light to set.


Comments

Commenter's Profile Image David Stangl
July 28th, 2012
Nice approach. I will remember this for the next bike accident I see
Commenter's Profile Image Val Cuarto
July 31st, 2012
Do you have a youtube video of this. This sounds like an interesting prcoedure that we can benefit from! Thank You
Commenter's Profile Image Jeff Kesling
August 2nd, 2012
I currently have a patient with the exact scenario you describe. How do you handle it if the patient has a steep overbite and little if any room to bond to the lingual of the maxillary anterior teeth? Would you prep the teeth to create room for the wire or Ribbond? Thanks!
Commenter's Profile Image Mark J Fleming DDS
August 4th, 2012
That's a clinical decision that one needs to make with the input of the patient. If the patient is not onboard with prepping adjacent teeth, the clinician may have to pursue other ways of creating the site, i.e. essix retainer.